Starting down the road of fertility treatment and beginning a family can be difficult. This road gets especially complicated for those in the LGBTQ community. Things like donors, gestational carriers, and egg or sperm freezing all come into the picture. These treatments can become expensive and time consuming, so it’s important to know your options.
Lesbian couples looking to start a family have a few things to consider. The first thing to think about is what role each partner will play in the family building process.
Whose eggs will be used to create the pregnancy?
Who will carry the pregnancy?
Do both partners want to have children who are genetically related to them?
Once you’ve discussed some of these questions, you can think about how that narrows treatment options.
The next thing to think about is sperm source. Donor Sperm must be used for same sex female couples. The donor sperm can be from a known donor or can be anonymous donor sperm purchased from a cryobank.
Known donors can be family members of the non-egg-providing partner or friends who agree to donate their sperm to the patients for the intended use of conceiving a pregnancy. Known donors are required to sign legal paperwork stating that they will not have parental rights over the child(ren) born from their donated sperm. Known donors do not need to undergo the government-mandated FDA infectious disease testing that anonymous donors must go through, so selecting a known donor tends to be a less expensive process.
Anonymous donor sperm is selected by sorting through donor profiles at a Cryobank. Once you agree upon a donor, you can purchase the sperm and it will be shipped to your fertility clinic to be used for your treatment cycle. Anonymous donors are required to complete a blood panel through the FDA verifying that they do not have any infectious diseases that could possibly be passed through the sperm sample.
Things to consider when getting sperm from a donor:
How many vials of sperm will you need? If you are planning to do multiple cycles of treatment with the same donor, it may be best to get a few vials.
If you’re purchasing anonymous donor sperm, is your donor exclusive or is there a possibility that other families can purchase sperm from the same donor? It's important to confirm your preference with the cryobank before selecting a donor.
Treatment options for lesbian couples looking to start a family are IUI, IVF, and Reciprocal IVF.
IUI stands for Intrauterine Insemination. In an IUI, a concentrated sperm sample is placed into the uterus by a doctor using a very thin and flexible plastic catheter. This procedure is timed alongside ovulation. There are two types of IUIs: natural and medicated.
Natural IUI cycles consist of a patient (who was assigned female at birth) using Ovulation Predictor Kit (OPK) each day to detect when their body is ready to ovulate. Once the test is positive, the patient will call the clinic to schedule the IUI. In order to be a candidate for Natural IUI, the patient must have regular menstrual cycles and consistent ovulation each month.
Medicated IUI cycles consist of a patient (who was assigned female at birth) taking medication to stimulate the ovaries to grow an egg to maturity. During the treatment, the medications are taken during the first half of the cycle, and during the second half of the cycle, OPKs are used to determine when the egg is ready to ovulate. Once the OPK is positive, sometimes the patient is instructed to do a trigger shot to enhance the hormone surge that causes ovulation. Then the patient will call the clinic to schedule the IUI.
In either case, the patient uses a home pregnancy test 14 days after the IUI to determine if the IUI was successful.
Another option to create a family is In Vitro Fertilization (IVF). IVF is a type of fertility treatment where a patient assigned female at birth injects hormonal medications to stimulate the ovaries to grow multiple eggs to maturity.
Once these eggs are determined to be mature, they are removed through a minor procedure called an Egg Retrieval. This short procedure is completed under a light anesthetic and lasts only about 15 minutes, but does require at least a full day of recovery time. Once retrieved, the eggs are cultured with sperm in the embryology lab. The embryos are then allowed to grow and develop, typically for three to seven days. Once the embryos reach a certain stage of development, one can either be transferred into the patient’s uterus and the rest frozen or all of the embryos can be frozen to be used at a later date.
Reciprocal IVF is IVF that involves both partners in a same sex female couple. In Reciprocal IVF, one partner does the IVF medications and retrieves the eggs to create embryos. Once the embryos are ready, one will be transferred into the uterus of the other partner. This gives both partners a way to physically participate in the process.
For gay male couples, there are a few considerations when looking into starting a family.
Whose sperm will be used to create the embryos?
What type of egg donor will you plan to use?
Who will carry the pregnancy?
For gay male couples, there are several options for providing the sperm to create embryos.
The first option is to collect sperm from one partner and use it to fertilize all of the donor eggs. The second option is to split the eggs into two batches and fertilize one batch with sperm from one partner and the second batch with sperm from the other partner. This option allows for both partners to have the opportunity to have genetically related children. Discuss both options as a couple to determine what seems like the best fit for your family goals.
The first consideration is the egg source. Options include:
a known egg donor (a friend of the couple or a family member of the non-sperm-providing male partner)
a donor (chosen from a donor agency), who will go through an IVF cycle to create embryos with the sperm from one or both male partners
frozen eggs (purchased from an egg bank), which will be thawed and fertilized using one or both partners’ sperm.
The other major consideration for gay male couples looking to start a family is choosing a gestational carrier. A gestational carrier is a person who carries a pregnancy for someone else.
Gestational Carrier vs. Surrogate
Though commonly used interchangeably, these terms have different meanings. A gestational carrier has no genetic relationship to the baby that they carry. A surrogate is the genetic mother of the baby that they carry. It is most common to use a gestational carrier.
A gestational carrier can be someone you know or someone you find through a gestational carrier agency. Gestational carriers hired through an agency can be very expensive, which can play a big role in the decision-making process.
What do I need to know about selecting a gestational carrier?
In order to qualify as a gestational carrier, a person must have carried and delivered at least one full term pregnancy without complication. The prospective carrier must also pass psychological and physical health examinations to confirm they are able to safely carry the pregnancy to term.
Once a gestational carrier is chosen, the carrier undergoes a medicated Frozen Embryo Transfer (FET) using an embryo previously created with donor eggs. During the FET process, the gestational carrier takes estrogen and progesterone medications to grow and prepare a uterine lining for an embryo to implant. Once the lining is thick enough, an embryo is thawed and transferred into the gestational carrier’s uterus. The goal is for the embryo to implant in the lining of the uterus and develop into a successful pregnancy.
For trans patients contemplating hormonal or surgical treatments, it’s important to think about family planning goals prior to commencing medical transition. If there’s a possibility you may want to start a family using your own sperm or eggs in the future, it’s a great idea to look into sperm or egg freezing now.
What if I’ve already surgically transitioned?
If you’ve already fully surgically transitioned and no longer have the reproductive organs that you were born with, using donor eggs, donor sperm, or a gestational carrier are options to reach your goal of starting a family. Speak to your fertility specialist about what options will work best for your personal journey.
For a patient who was assigned as male at birth, sperm freezing is the method of preserving future fertility. Sperm freezing and storage is typically done at a fertility clinic or Cryobank. The cryobank will have you come to the clinic and collect semen in a sterile collection cup. The lab will then assess the sample for sperm count and quality and then freeze it. It’s often advised to freeze multiple sperm samples to ensure there’s enough frozen sperm for fertilizing eggs to achieve your desired family size.
Similarly, patients who were assigned female at birth can investigate freezing their eggs prior to pursuing hormonal or surgical steps towards transitioning. Freezing eggs is a considerably more involved process compared to freezing sperm. In an egg freezing cycle, the patient takes injectable hormone medications for approximately 10-14 days to stimulate the ovaries to grow as many mature eggs as possible. When the doctor determines the eggs are mature, the patient will be scheduled for an egg retrieval procedure. This short procedure is completed under a light anesthetic and lasts only about 15 minutes, but does require at least a full day of recovery time. When the eggs are retrieved, the lab will sort the eggs and freeze only the mature eggs that, when thawed later, will be able to be fertilized with sperm to create an embryo.
Fertility treatment can be an overwhelming journey for many patients. Knowing the options available to you is the first step in planning for your current and future fertility and family planning goals. Once you’re ready to get started, speak with your reproductive endocrinologist about which options are best for you and your family.